I am a plastic surgeon in Little Rock, AR. I used to "suture for a living", I continue "to live to sew". These days most of my sewing is piecing quilts. I love the patterns and interplay of the fabric color. I would like to explore writing about medical/surgical topics as well as sewing/quilting topics. I will do my best to make sure both are represented accurately as I share with both colleagues and the general public.

Quilts of Valor

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Wednesday, January 16, 2008

It was a quiet late summer Saturday afternoon. The pager went off. The message--Call TT at 555-5555.

I always do a mental check list of possible problems when I recognize the patient's name. This one had had a tummy tuck done 6 weeks previously. She had healed with no problems or issues. She hadn't asked for a refill on pain medication. All of her follow up visits had been routine. I couldn't begin to image why she was having me paged.

"TT, this is Dr. Bates. How can I help you?"

"Dr. Bates, my incision has popped open!"

"Slow down and take a deep breath. Try to stop crying and repeat what you just said. I'm not sure I understood you."

"I fell when I stepped out of the boat. I landed on some gravel and my incision on my right side has opened up."

"Okay, where are you and how long do you think it would take to get to my office? The building is locked because it's Saturday, but I can get us in. I'll look at you there and if I can I'll fix it for you there, I will." No need to further stress her with the possibility of surgery at the hospital. She was already thinking of the added cost of this, having maxed out her savings and credit to have the initial surgery. "Just come on"

"It'll take us about two hours. I'm all dirty. I need to change clothes."

"Don't worry about your clothes, just come."

Boy, was I surprised! As my husband likes to say, "you can't make this stuff up". This is not a "complication" that you warn patients about after surgery. This is different from wound dehiscence. This literally was a healed wound that had incurred the pressure of the fall onto one rock with the point of maximum force right over the healed scar at her right hip. Scars at 6 weeks are only at approximately 55% of the final strength that will be reached at approximately 10-12 weeks post-injury. Even then scars only have 80% of the tensile strength of uninjured skin. But what are the odds.........

When they arrived at my office, I found an open wound about 18 cm long, gaping nearly 5 cm at the widest point. It was centered over the right anterior hip bone. There was dirt, grass, and small gravel in the wound. There was no active bleeding . I got her to lay down on the exam table and did a local block using 0.5% Lidocaine with Epi and 0.5% Marcaine without Epi. Then I thoroughly cleaned the wound out with normal saline and Betadine solution, picking out the grass and gravel. Cleaned some more. Then I closed the wound with vicryl and PDS. I reassured her that most likely in two years, we wouldn't be able to tell which part of the scar had been reopened. I sent her home on antibiotics, but she declined pain medicine (had some left over from the surgery). Both TT and I were relieved that it wasn't any more serious than it was.

Now when patients ask for 100% guarantees of their postop courses, I use this example of how even best laid plans can be changed by "life", the "universe", whatever. Some things are not in our control. I tell them I will do everything I can to ensure a good outcome. I ask them to help me by following instructions and using common sense. But what are the odds.....

I'm coming to Arkansas if and when I ever get the nerve to get a nip or tuck on my aging self. You are one cool surgical asset: take a deep breath, drive two hours, and I'll pick your dehisced wound free of gravel and stitch you up in the office.

Disclaimer

My purpose in writing my blog is to attempt to provide good solid medical information on topics of my choosing. It is a way to educate myself, my colleagues, and the general public. References will be provided on medical posts, but not on opinion essays or poetry posts. An additional purpose is to share my interest in quilting topics, a way to show my human side.

Any medical information provided by this site is not a replacement for medical diagnosis, treatment, or professional medical advice. It should not be used to treat or diagnose any medical condition. Always seek professional medical consultation by a licensed physician for diagnosis and treatment of any and all medical conditions - please, do not ignore your doctor's medical advice based on information written by the author or commenters of this site. Please do not ask me for medical advice, but instead contact a healthcare provider in your area. Anything written about office/hospital situations/events are fictional examples to get a point across. No patient is/will ever be a specific patient (unless given written permission), but a fictional one. To know more about how I handle medical information about patients please link here. Unless, I am praising a colleague, even those will be fictional. Any similarities to you or people you know is purely coincidental. My husband and I, and our dogs are fair game.

In early 2009 I joined the Better Health Network. As part of that Network, I will occasionally be paid for my writing. Those posts will be clearly noted. I will strive to maintain my high ethical standards. If I add any advertising, it will be clearly marked as such.

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I do not intend to use this blog to collect or dispense private health information on patients. If any patient is used as an explicit example for a posting, I will get that patient's consent in writing to use their story and/or photo. The office is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. However, that is not the intent of this blog. I intend to share information on medical/quilting topics with the general public and my colleagues. This web site does not share or sell any personal information, including your name, address, or email addresses with third parties. Have a blessed day!